{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T09:56:48Z","timestamp":1767952608804,"version":"3.49.0"},"reference-count":19,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Caesarean section plays a crucial role in ensuring the health of both mother and newborn, especially when complications arise or are anticipated. However, the increasing global prevalence of caesarean section brings along significant postoperative challenges, notably pelvic adhesions, which can impact subsequent pregnancies and surgeries. Non-invasive preoperative assessment methods, such as ultrasonography, offer promise in enhancing surgical planning and patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to evaluate the accuracy of transabdominal and transvaginal sliding sign in detecting intraabdominal adhesions in third-trimester pregnant women with a history of caesarean section.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This diagnostic study recruited 35 third-trimester pregnant women with a history of cesarean section undergoing scheduled repeat cesarean at a tertiary referral hospital. All participants underwent both via transvaginal (TV) and transabdominal (TA) ultrasound before surgery. The presence of a positive or negative sliding sign was recorded for each modality. Intra-abdominal adhesions were confirmed intraoperatively and used as the gold standard. Diagnostic accuracy was calculated for each modality. Comparative analysis was conducted across patient characteristics and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>All 35 patients underwent both TA and TV ultrasound evaluations (within-subject design). The majority of participants were aged between 31 and 40 years (68.6%), were multigravida (65.7%), and had undergone two caesarean sections (51.4%). The sliding sign was negative in 18 (51.4%) and 17 (48.6%) patients using TA and TV approaches, respectively. Both modalities showed high sensitivity (93.75%) and specificity (84.21%) in detecting adhesions. There was no statistically significant difference between TA and TV sliding signs in relation to age or obstetric status. Comparative analysis of both modalities showed equivalent diagnostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both transabdominal and transvaginal sliding sign evaluations demonstrate high accuracy in detecting intra-abdominal adhesions in women undergoing repeat cesarean section. The within-subject comparison suggests either modality may be reliably used depending on clinical and logistic factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.20551","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:34:18Z","timestamp":1767947658000},"page":"e20551","source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of transvaginal and transabdominal sliding sign for predicting intra-abdominal adhesions prior to repeat cesarean section: a single center study"],"prefix":"10.7717","volume":"14","author":[{"given":"Peby Maulina","family":"Lestari","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imas Kartika","family":"Dewi E","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abarham","family":"Martadiansyah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodorus","family":"Theodorus","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuswil","family":"Bernolian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Putri","family":"Mirani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Al Farisi","family":"Sutrisno","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bella","family":"Stevanny","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Faculty of Medicine, Sriwijaya University, Palembang, South Sumatra, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4443","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"issue":"12","key":"10.7717\/peerj.20551\/ref-1","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1177\/1933719111414206","article-title":"Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review","volume":"18","author":"Awonuga","year":"2011","journal-title":"Reproductive Sciences"},{"issue":"2","key":"10.7717\/peerj.20551\/ref-2","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/uog.17465","article-title":"Accuracy of preoperative real-time dynamic transvaginal ultrasound sliding sign in prediction of pelvic adhesions in women with previous abdominopelvic surgery: prospective, multicenter, double-blind study","volume":"51","author":"Ayachi","year":"2018","journal-title":"Ultrasound in Obstetrics & Gynecology"},{"issue":"8","key":"10.7717\/peerj.20551\/ref-3","doi-asserted-by":"publisher","first-page":"CD000163","DOI":"10.1002\/14651858.CD000163.pub2","article-title":"Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes","volume":"2014","author":"Bamigboye","year":"2014","journal-title":"The Cochrane Database of Systematic Reviews"},{"issue":"5","key":"10.7717\/peerj.20551\/ref-4","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1002\/uog.19057","article-title":"Sliding sign in third-trimester sonographic evaluation of intra-abdominal adhesions in women undergoing repeat Cesarean section: a novel technique","volume":"52","author":"Baron","year":"2018","journal-title":"Ultrasound in Obstetrics & Gynecology"},{"key":"10.7717\/peerj.20551\/ref-5","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1016\/S0140-6736(18)30001-1","article-title":"Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study","volume":"391","author":"Biccard","year":"2018","journal-title":"The Lancet"},{"key":"10.7717\/peerj.20551\/ref-6","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/S0140-6736(18)31928-7","article-title":"Global epidemiology of use of and disparities in caesarean sections","volume":"392","author":"Boerma","year":"2018","journal-title":"The Lancet"},{"issue":"2","key":"10.7717\/peerj.20551\/ref-7","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/0029-7844(94)00352-E","article-title":"The incidence of adhesions after prior laparotomy: a laparoscopic appraisal","volume":"85","author":"Brill","year":"1995","journal-title":"Obstetrics & Gynecology"},{"key":"10.7717\/peerj.20551\/ref-8","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1097\/AOG.0000000000002480","article-title":"Sliding sign for intra-abdominal adhesion prediction before repeat caesarean delivery","volume":"131","author":"Drukker","year":"2018","journal-title":"Obstetrics and Gynecology"},{"issue":"2","key":"10.7717\/peerj.20551\/ref-9","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1002\/uog.7689","article-title":"Value of transvaginal ultrasound in assessing severity of pelvic endometriosis","volume":"36","author":"Holland","year":"2010","journal-title":"Ultrasound in Obstetrics and Gynecology"},{"key":"10.7717\/peerj.20551\/ref-10","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1093\/humrep\/dep013","article-title":"Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis","volume":"24","author":"Hudelist","year":"2009","journal-title":"Human Reproduction"},{"issue":"6","key":"10.7717\/peerj.20551\/ref-11","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1002\/uog.29133","article-title":"Transabdominal sonographic sliding signs for preoperative prediction of dense intra-abdominal adhesions in women undergoing repeat Cesarean delivery","volume":"64","author":"Mayibenye","year":"2024","journal-title":"Ultrasound in Obstetrics & Gynecology"},{"issue":"3","key":"10.7717\/peerj.20551\/ref-12","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1002\/j.2205-0140.2013.tb00099.x","article-title":"The \u2018sliding sign\u2019 in conjunction with sonovaginography: is this the optimal approach for the diagnosis of Pouch of Douglas obliteration and posterior compartment deep infiltrating endometriosis?","volume":"16","author":"Menakaya","year":"2013","journal-title":"Australasian Journal of Ultrasound in Medicine"},{"key":"10.7717\/peerj.20551\/ref-13","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1002\/uog.14628","article-title":"Prevalence of pelvic adhesions on ultrasound examination in women with a history of Caesarean section","volume":"45","author":"Moro","year":"2015","journal-title":"Ultrasound in Obstetrics and Gynecology"},{"issue":"250","key":"10.7717\/peerj.20551\/ref-14","doi-asserted-by":"publisher","first-page":"517","DOI":"10.31729\/jnma.7547","article-title":"Intra-abdominal adhesions among patients undergoing repeat caesarean section in department of obstetrics and gynaecology of a tertiary care centre: a descriptive cross-sectional study","volume":"60","author":"Pokhrel","year":"2022","journal-title":"JNMA Journal of Nepal Medical Association"},{"key":"10.7717\/peerj.20551\/ref-15","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1002\/uog.12469","article-title":"Transvaginal sonographic sliding sign: accurate prediction of pouch of Douglas obliteration","volume":"41","author":"Reid","year":"2013","journal-title":"Ultrasound in Obstetrics and Gynecology"},{"key":"10.7717\/peerj.20551\/ref-16","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.ejogrb.2023.05.039","article-title":"Prediction of intraperitoneal adhesions in repeated cesarean sections: a systematic review and meta-analysis","volume":"287","author":"Shafti","year":"2023","journal-title":"The European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"issue":"1","key":"10.7717\/peerj.20551\/ref-17","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.fertnstert.2013.10.026","article-title":"Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy?","volume":"101","author":"Stocker","year":"2014","journal-title":"Fertility and Sterility"},{"issue":"1","key":"10.7717\/peerj.20551\/ref-18","doi-asserted-by":"publisher","first-page":"29","DOI":"10.18295\/squmj.10.2024.063","article-title":"Diagnostic accuracy of abdominal ultrasonographic sliding sign in the evaluation of severe intra-abdominal adhesions involving the uterus in women undergoing repeat caesarean delivery: systematic review and meta-analysis","volume":"25","author":"Taha","year":"2025","journal-title":"Sultan Qaboos University Medical Journal"},{"issue":"2","key":"10.7717\/peerj.20551\/ref-19","doi-asserted-by":"publisher","first-page":"132e1","DOI":"10.1016\/j.ajog.2010.09.005","article-title":"Prospective study of intraabdominal adhesions among women of different races with or without keloids","volume":"204","author":"Tulandi","year":"2011","journal-title":"American Journal of Obstetrics & Gynecology"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/20551.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20551.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20551.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/20551.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:34:21Z","timestamp":1767947661000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/20551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":19,"alternative-id":["10.7717\/peerj.20551"],"URL":"https:\/\/doi.org\/10.7717\/peerj.20551","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"article-number":"e20551"}}